Once the fall rolls around, many people head to their local pharmacy for a flu shot, a practice they’ve been taking part in for years. In fact, the first flu vaccines were approved all the way back in 1945, according to the Mayo Clinic. On the other hand, the vaccines for respiratory syncytial virus, or RSV, were all approved for use in the United States within the last three years. So it’s not surprising if you still have questions, such as what are the most common RSV vaccine side effects?
Meet the experts: Amesh A. Adalja, M.D., is a senior scholar at the Johns Hopkins Center for Health Security; Thomas Russo, M.D., is a professor and chief of infectious diseases at the University at Buffalo in New York; William Schaffner, M.D., is an infectious disease specialist and professor at the Vanderbilt University School of Medicine.
While everyone will react slightly differently to vaccines, there are some common side effects of the RSV vaccine to be aware of. Here, experts break down the differences among the three RSV vaccines that have been approved for use in the U.S., plus the possible side effects, when you should be concerned about a reaction to the vaccine, and if it’s safe to get.
What is RSV?
Respiratory syncytial virus, a.k.a. RSV, is a common respiratory virus that usually causes mild, cold-like symptoms, according to the Centers for Disease Control and Prevention (CDC). While most people recover from the virus in a week or two, others—namely infants and older adults—can experience serious complications like pneumonia and need to be hospitalized.
“RSV is a ubiquitous respiratory virus that is comparable in severity to influenza in older adults,” said Amesh A. Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security.
Each year, RSV infections causes between 110,000 and 180,000 hospitalizations in adults over 50, per CDC data. The CDC says it also leads to between 58,000 and 80,000 hospitalizations in children under the age of 5.
Available RSV vaccines
There are currently three types of RSV vaccines approved for use in the U.S.:
- Arexvy is approved for people ages 50 and older and people between 50 and 59 who are at an increased risk for lower respiratory tract disease caused by RSV
- Abrysvo is approved for people ages 60 and older, people between 18 and 59 who are at an increased risk of lower respiratory tract disease caused by RSV, and pregnant women at 32 to 36 weeks for the prevention of lower respiratory tract disease in their babies
- mResvia is approved for people ages 60 and older and people between 18 and 59 who are at an increased risk for lower respiratory tract disease caused by RSV
According to the CDC, one dose of RSV vaccine provides protection against RSV to adults over 50 for at least two years.
Possible RSV vaccine side effects in older adults
The CDC lists the following as possible side effects of the RSV vaccine:
- Pain, redness, and swelling where the shot is given
- Fatigue
- Fever
- Headache
- Nausea
- Diarrhea
- Muscle or joint pain
“Overall, the vaccine seems to be pretty well tolerated,” said Thomas Russo, M.D., a professor and chief of infectious diseases at the University at Buffalo in New York. “For the most part, these side effects are what we expect with most vaccines.”
William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine, agreed. “Most side effects are ones you would expect,” he said. “A small number of people—as with any vaccine—may feel out of sorts for a little bit.”
Side effects are usually “mild and self-limited,” Dr. Russo added, resolving within 24 to 48 hours in people who experience them.
What is a severe reaction to the RSV vaccine?
The Food and Drug Administration (FDA) has flagged a rare but potential link between the RSV vaccine—particularly Arexvy—and neurological complications. That includes Guillain-Barré syndrome, a rare disorder where the body’s immune system damages nerve cells, leading to muscle weakness and sometimes paralysis.
The FDA notes that, in one of the clinical trials for the vaccine, two of the participants (out of about 2,500) developed acute disseminated encephalomyelitis (ADEM), a rare type of inflammation that affects the brain and spinal cord, seven and 22 days after receiving the RSV and flu vaccine at the same time. One of those study participants died.
In another study, one participant (again out of 2,500) developed Guillain-Barré syndrome nine days after receiving the vaccine.
In one study on Abrysvo of over 18,500 people, one person developed Guillain-Barré syndrome seven days after they were vaccinated, while another developed Miller Fisher Syndrome, which is a rare form of Guillain-Barré syndrome, eight days after they received the vaccine.
You can develop Guillain-Barré syndrome from other causes, making it tricky to pin it to the vaccines. “Given the small number, it is unclear whether the vaccine caused these events, or whether they occurred due to chance,” Dr. Adalja said.
“Both the FDA and CDC’s advisory committee thought that these cases were probably coincidental, but that’s something that people are keeping an eye on,” Dr. Schaffner said.
Is the RSV vaccine safe to get?
On the whole, doctors said the vaccine is safe. “The RSV vaccine is very safe based on the clinical trial data,” Dr. Adalja said. “The risk-benefit ratio favors it in the approved groups.”
Dr. Schaffner agreed. “The vaccine is safe,” he said, adding that both he and his wife get it.
Ultimately, Dr. Russo said that choosing to get the RSV vaccine comes down to your individual risk-benefit ratio. “There’s little question that if you’re 60 and older and you have significant underlying cardiac disease, pulmonary disease, or other significant comorbidities, the benefits of vaccination really outweigh any potential risks,” he said. “Those people should get vaccinated. RSV can be as deadly as influenza.”
But, Dr. Russo said, if you’re “perfectly healthy” and over 60, he recommended talking to your healthcare provider about whether you should receive the vaccine. “Certainly in high-risk groups, there’s little question where the benefit exceeds a potential and ill-defined risk,” he added.
Is there anyone who should not get the RSV vaccine?
The CDC says that you should not get the RSV vaccine if you’ve ever had a severe allergic reaction to any component of the vaccine. (You can find details on the ingredients and allergy risks for each of the three in the vaccine links above.)
If you’re interested in the RSV vaccine but unsure if it’s right for you, talk to your doctor for personalized guidance.
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